Telemedicine applied to kinesiotherapy for hand dysfunction in patients with systemic sclerosis and rheumatoid arthritis: recovery of movement and telemonitoring technology.

OBJECTIVE: To describe a feasibility study focused on a telemonitoring approach to self-managed kinesiotherapy sessions for the rehabilitation of hand function in patients with systemic sclerosis (SSc) and rheumatoid arthritis (RA). METHODS: Ten patients with SSc and 10 with RA were enrolled in a 3-month controlled trial (approval no. 9751/2012 - Italian Department of Health) to perform a home kinesiotherapy protocol, consisting of strengthening and mobility exercises, using a newly developed telemedicine system (a portable device and the related telemonitoring infrastructure). A further 10 patients with SSc and 10 with RA were enrolled as controls to perform a similar home kinesiotherapy protocol with the aid of common daily-life objects. Both groups were evaluated at baseline and at followup, after 6 and 12 weeks. The primary outcome of the trial was hand function measured by Dreiser's index (Functional Index for Hand OA, FIHOA), Health Assessment Questionnaire (HAQ), and the Hand Mobility in Scleroderma (HAMIS) test (only for SSc). RESULTS: Patients with SSc showed an improvement of FIHOA in both arms (p < 0.01) but the HAQ (p = 0.016) and the HAMIS test (right hand p = 0.016, left hand p = 0.075) improved significantly only in the experimental arm. Patients with RA showed a statistically significant improvement of FIHOA (p = 0.013) and HAQ (p = 0.015) in the experimental arm, while patients in the control arm did not significantly improve. However, no statistically significant differences in outcome measures between treatment methods were observed. Withdrawals were higher in control arms (SSc 20%; RA 30%) than in experimental arms (SSc 10%; RA 10%). CONCLUSION: Telemonitoring of self-administered kinesiotherapy programs is a promising approach to the rehabilitation of hand functions in patients with rheumatic disease.

A Device for Local or Remote Monitoring of Hand Rehabilitation Sessions for Rheumatic Patients.

Current clinical practice suggests that recovering the hand functionality lost or reduced by injuries, interventions and chronic diseases requires, beyond pharmacological treatments, a kinesiotherapic intervention. This form of rehabilitation consists of physical exercises adapted to the specific pathology. Its effectiveness is strongly dependent on the patient's adhesion to such a program. In this paper we present a novel device with remote monitoring capabilities expressly conceived for the needs of rheumatic patients. It comprises several sensorized tools and can be used either in an outpatient clinic for hand functional evaluation, connected to a PC, or afforded to the patient for home kinesiotherapic sessions. In the latter case, the device guides the patient in the rehabilitation session, transmitting the relevant statistics about his performance to a TCP/IP server exploiting a GSM/GPRS connection for deferred analysis. An approved clinical trial has been set up in Italy, involving 10 patients with Rheumatoid Arthritis and 10 with Systemic Sclerosis, enrolled for 12 weeks in a home rehabilitation program with the proposed device. Their evaluation has been performed with traditional methods but also with the proposed device. Subjective (hand algofunctional Dreiser's index) and objective (ROM, strength, dexterity) parameters showed a sustained improvement throughout the follow-up. The obtained results proved that the device is an effective and safe tool for assessing hand disability and monitoring kinesiotherapy exercise, portending the potential exploitability of such a methodology in clinical practice.

Energy expenditure during competitive Latin American dancing simulation.

UNLABELLED: The aims of this study were to estimate the energy expenditure (EE) and the intensity of physical activity (PA) during a competitive simulation of Latin American dancing and to evaluate the differences in PA and EE values between the sexes, between different dance types, and between the various phases of the competition. METHODS: Ten Italian dancers (five couples, 5 males and 5 females) competing in Latin American dancing at the international level were examined in this study. The EE (kcal) was measured during the semifinal and final phases of the competition using the SenseWear Pro Armband (SWA). Paired-sample t-tests were used to determine differences in the metabolic equivalent (MET) and EE values between the semifinal and final phases and between each dance. One-way analysis of variance was used to analyze the differences in the MET and EE values between the sexes. RESULTS: The intensity of PA during the dance sequence ranged from moderate (3 to 6 METs) to vigorous (6 to 9 METs). The male dancers had higher EE values than the female dancers during all phases of the simulation. Similar MET values were observed in both sexes. The PA intensity during the finals phase was vigorous for 56% of the time of dance. Of all the dance styles, the rumba had the lowest MET and EE values. CONCLUSION: Our results demonstrate that competitive Latin American dancing is a heavy exercise and suggest that monitoring variables during normal training can improve training protocols and the dancers' fitness levels.